mosby’s pathology lesson 4.1 objectives … · corn and callus skin thickening from repeated...

Chapter 4Chapter 4

Dermatologic PathologiesDermatologic Pathologies

Mosby’s PATHOLOGY

for Massage Therapists

Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.2


Lesson 4.1 ObjectivesLesson 4.1 Objectives

�� Discuss anatomic structures and physiologic Discuss anatomic structures and physiologic

processes related to the processes related to the integumentaryintegumentary

system.system.

�� Contrast and compare primary and secondary Contrast and compare primary and secondary

skin lesions.skin lesions.

3Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

3

IntegumentaryIntegumentary System OverviewSystem Overview

�� The The integumentaryintegumentary system includes the skin system includes the skin

and its accessory structures:and its accessory structures:

�� HairHair

�� NailsNails

�� Various glandsVarious glands

�� Various musclesVarious muscles

�� Various nervesVarious nerves


4

IntegumentaryIntegumentary System OverviewSystem Overview(cont(cont’’d.)d.)

�� The skin is divided The skin is divided

into two distinct into two distinct

regions:regions:

�� EpidermisEpidermis

�� DermisDermis

From Jarvis C: From Jarvis C: Physical exam and health assessment, Physical exam and health assessment, eded 4, 4,

Philadelphia, 2004, Saunders.Philadelphia, 2004, Saunders.


5


�� The epidermis is the most superficial skin The epidermis is the most superficial skin

layer and contains:layer and contains:

�� KeratinocytesKeratinocytes (skin cells)(skin cells)

�� MelanocytesMelanocytes (contribute to skin color)(contribute to skin color)

�� NailsNails

�� Pores (allow passage for hair and glands)Pores (allow passage for hair and glands)


6


�� The dermis is beneath the epidermis and The dermis is beneath the epidermis and

contains:contains:

�� Blood vesselsBlood vessels

�� Sensory nerve receptorsSensory nerve receptors

�� CollagenCollagen

�� ElastinElastin


7


�� Subcutaneous layer:Subcutaneous layer:

�� Beneath the dermisBeneath the dermis

�� Also known as superficial fascia or hypodermisAlso known as superficial fascia or hypodermis

�� Not part of the skin but anchors skin to underlying Not part of the skin but anchors skin to underlying

tissues and organstissues and organs


8


�� Skin functions:Skin functions:

�� ProtectionProtection

�� AbsorptionAbsorption

�� Sensory receptionSensory reception

�� Temperature regulationTemperature regulation

�� Vitamin D productionVitamin D production


9


�� Hairs:Hairs:

�� grow from folliclesgrow from follicles

�� protect scalp, eyes, nostrils, earsprotect scalp, eyes, nostrils, ears

�� have touch receptors (activated by hair movement)have touch receptors (activated by hair movement)

�� arrectorarrector pilipili muscle (erect hairs)muscle (erect hairs)


10


�� Nails:Nails:

�� are plates of tightly packed epidermis cellsare plates of tightly packed epidermis cells

�� help when grasping and manipulating objectshelp when grasping and manipulating objects

�� protect ends of fingers and toesprotect ends of fingers and toes

�� enable scratching to remove irritantsenable scratching to remove irritants


11


�� Front view and cross section of a nail:Front view and cross section of a nail:

From Salvo S: From Salvo S: Massage therapy: principles and practice, Massage therapy: principles and practice, eded 3, St. Louis, 2007, Saunders.3, St. Louis, 2007, Saunders.


12

Dermatologic PathologiesDermatologic Pathologies

�� Skin lesionsSkin lesions

�� Defined as any deviation from the normDefined as any deviation from the norm

�� Two categoriesTwo categories

•• Primary: variation in skin color or texture (ex. freckle, Primary: variation in skin color or texture (ex. freckle,

blister) blister)

•• Secondary: develops from a primary lesion, disease Secondary: develops from a primary lesion, disease

progression, or external forces (ex. ulcer, scar)progression, or external forces (ex. ulcer, scar)

�� Differentiations not always clear Differentiations not always clear


13

Dermatologic Pathologies Dermatologic Pathologies (cont'd.)(cont'd.)

�� Primary skin lesionsPrimary skin lesions

�� MaculeMacule

�� PatchPatch

�� PapulePapule

�� PlaquePlaque

�� WhealWheal

�� NoduleNodule

�� Tumor Tumor

�� VesicleVesicle

�� BullaBulla

�� PustulePustule

�� CystCyst

�� TelangiectasiaTelangiectasia


14

Dermatologic Pathologies Dermatologic Pathologies (cont'd.)(cont'd.)

�� Secondary skin lesionsSecondary skin lesions

�� AtrophyAtrophy

�� ScarScar

�� ScaleScale

�� LichenificationLichenification

�� CrustCrust

�� ErosionErosion

�� Excoriation Excoriation

�� UlcerUlcer

�� Fissure Fissure

�� PurpuraPurpura

•• PetechiaePetechiae

•• EcchymosesEcchymoses


15


�� Define bacterial skin infections and list Define bacterial skin infections and list

appropriate massage considerations.appropriate massage considerations.

�� Identify fungal skin infections and list appropriate Identify fungal skin infections and list appropriate

massage considerations.massage considerations.

�� Name viral infections that affect the skin and Name viral infections that affect the skin and

state appropriate massage considerations.state appropriate massage considerations.


16

Lesson 4.2 Objectives Lesson 4.2 Objectives (cont(cont’’d.)d.)

�� Discuss inflammatory skin conditions and list Discuss inflammatory skin conditions and list

appropriate massage considerations.appropriate massage considerations.

�� List materials and chemicals known to cause List materials and chemicals known to cause

contact dermatitis.contact dermatitis.


17

Bacterial Skin InfectionsBacterial Skin Infections

�� AcneAcne

�� ImpetigoImpetigo

�� ParonychiaParonychia

�� FolliculitisFolliculitis

�� Boils (furuncles and carbuncles)Boils (furuncles and carbuncles)

�� CellulitisCellulitis

�� ErysipelasErysipelas


18

AcneAcne

�� Inflammatory infection of hair follicles and Inflammatory infection of hair follicles and

associated sebaceous glandsassociated sebaceous glands

�� Presence of Presence of comedoscomedos, papules, and pustules, papules, and pustules

�� Blackheads: open Blackheads: open comedoscomedos

�� Whiteheads: closed Whiteheads: closed comedoscomedos

�� Local contraindicationLocal contraindication


19

Acne Acne (cont(cont’’d.)d.)

From From NishiyamaNishiyama S, et al.: S, et al.: Atlas of regional dermatology: diagnosis and treatment, Atlas of regional dermatology: diagnosis and treatment, St. Louis, 1998, Mosby; White G: St. Louis, 1998, Mosby; White G: Color atlas of dermatologyColor atlas of dermatology, ,

eded 3, 2004, Elsevier, Ltd.; and 3, 2004, Elsevier, Ltd.; and HabifHabif: : Clinical dermatology: a color guide to diagnosis and therapy, Clinical dermatology: a color guide to diagnosis and therapy, eded 4, St. Louis, 2004, Mosby.4, St. Louis, 2004, Mosby.


20

ImpetigoImpetigo

�� Infection around mouth, nose and handsInfection around mouth, nose and hands

�� Vesicles or pustules itch or burn then burst, Vesicles or pustules itch or burn then burst,

leaving fluid that dries to form a crustleaving fluid that dries to form a crust

�� Massage is postponed until areas have Massage is postponed until areas have

completely healedcompletely healed


21

Impetigo Impetigo (cont(cont’’d.)d.)

From From HabifHabif T: T: Clinical dermatology: a color guide to diagnosis and therapy,Clinical dermatology: a color guide to diagnosis and therapy, eded 4, St. Louis, 2004, Mosby.4, St. Louis, 2004, Mosby.


22

ParonychiaParonychia

�� Infection surrounding the Infection surrounding the

nailnail

�� Affected area is red, Affected area is red,

swollen, painful and swollen, painful and

tender; nail plate can be tender; nail plate can be

discolored or deformeddiscolored or deformed


From From HabifHabif T: T: Clinical dermatology: a color guide to Clinical dermatology: a color guide to

diagnosis and therapy,diagnosis and therapy, eded 4, St. Louis, 2004, Mosby.4, St. Louis, 2004, Mosby.


23

FolliculitisFolliculitis

�� Inflammation limited to hair folliclesInflammation limited to hair follicles

�� PustularPustular rash with surrounding rednessrash with surrounding redness


From Habif T: Clinical dermatology: a color guide to diagnosis and therapy, ed 4, St. Louis, 2004, Mosby.24


Boil (Furuncle and Carbuncle)Boil (Furuncle and Carbuncle)

�� Infection of hair Infection of hair

follicles and follicles and

surrounding areas surrounding areas

�� Painful, tender, red, Painful, tender, red,

firm, swollen; abscess firm, swollen; abscess

formationformation


From From LookingbillLookingbill D, Marks J: D, Marks J: Principles of dermatology,Principles of dermatology, eded 4, Philadelphia, 2006, Saunders; 4, Philadelphia, 2006, Saunders;

and Lawrence CM, Cox NH: and Lawrence CM, Cox NH: Physical signs in dermatology: color atlas and text,Physical signs in dermatology: color atlas and text, eded 2, London, 2002, Mosby Europe.2, London, 2002, Mosby Europe.


25

CellulitisCellulitis and Erysipelasand Erysipelas

�� Infection of skin and subcutaneous tissues; Infection of skin and subcutaneous tissues; erysipelas is a superficial form of erysipelas is a superficial form of cellulitiscellulitis

�� Swelling, redness, warm and tender skinSwelling, redness, warm and tender skin

�� Local contraindication in localized cases; Local contraindication in localized cases; absolute contraindication in widespread casesabsolute contraindication in widespread cases


26

CellulitisCellulitis and Erysipelas and Erysipelas (cont(cont’’d.)d.)



27

Fungal Skin InfectionsFungal Skin Infections

�� RingwormRingworm

�� AthleteAthlete’’s foots foot

�� Jock itchJock itch

�� Nail fungusNail fungus


28

Ringworm (Ringworm (TineaTinea corporiscorporis))

�� Fungal skin infectionFungal skin infection

�� Red, raised, round/oval Red, raised, round/oval

scaling area with a scaling area with a

clear center clear center

�� Massage is Massage is

contraindicatedcontraindicated



29

AthleteAthlete’’s Foot (s Foot (TineaTinea pedispedis))

�� Fungal infection of the Fungal infection of the

footfoot

�� Skin discoloration with Skin discoloration with

a ridge of red tissuea ridge of red tissue




30

Nail fungus (Nail fungus (TineaTinea unguiumunguium))

�� Infection of the nailsInfection of the nails

�� Nails become yellow Nails become yellow

or white, raised, or white, raised,

thickened and brittlethickened and brittle


From From LookingbillLookingbill D, Marks J: D, Marks J: Principles of dermatology,Principles of dermatology, eded 3, 3,

Philadelphia, 2000, WB Saunders.Philadelphia, 2000, WB Saunders.


31

Jock Itch (Jock Itch (TineaTinea cruriscruris))

�� Fungal infection in groin areaFungal infection in groin area

�� Local contraindication if widespread (inner Local contraindication if widespread (inner

thighs, buttocks)thighs, buttocks)

A ,from Salvo S: A ,from Salvo S: Massage therapy: principles and practice, Massage therapy: principles and practice, eded 3, St. Louis, 2007, Saunders. 3, St. Louis, 2007, Saunders.

B, from B, from HabifHabif T: T: Clinical dermatology: a color guide to diagnosis and therapy,Clinical dermatology: a color guide to diagnosis and therapy, eded 4, St. Louis, 2004, Mosby.4, St. Louis, 2004, Mosby.


32

Viral Skin InfectionsViral Skin Infections

�� Cold sores and fever blistersCold sores and fever blisters

�� ChickenpoxChickenpox

�� ShinglesShingles

�� WartsWarts


33

Cold Sore and Fever BlisterCold Sore and Fever Blister

�� Recurrent infection of skin Recurrent infection of skin

and mucous membranes and mucous membranes

from HSVfrom HSV

�� Painful, fluidPainful, fluid--filled filled

vesicles; usually around vesicles; usually around

mouthmouth

�� Absolute contraindicationAbsolute contraindication

From From HabifHabif T, Campbell J, T, Campbell J, QuitadamoQuitadamo M, Zug K: M, Zug K: Skin Skin

disease: diagnosis and treatment,disease: diagnosis and treatment, St. Louis, 2001, Mosby.St. Louis, 2001, Mosby.


34

Chickenpox Chickenpox

�� Acute infection; affects Acute infection; affects mostly childrenmostly children

�� Itchy, widespread rash Itchy, widespread rash of fluidof fluid--filled blisters filled blisters that erupt and crust that erupt and crust overover

�� Massage is Massage is contraindicatedcontraindicated

From From CallenCallen JP, Greer KE, JP, Greer KE, PallerPaller AS, AS, SwinyerSwinyer LJ: LJ: Color atlas of Color atlas of

dermatology,dermatology, eded 2, Philadelphia, 2000, WB Saunders.2, Philadelphia, 2000, WB Saunders.


35

ShinglesShingles

�� Reactivated Reactivated varicellavaricella--

zoster viruszoster virus

�� Painful vesicles in Painful vesicles in

bandlikebandlike pattern along pattern along

dermatomesdermatomes


contraindicatedcontraindicated

From From LemmiLemmi FD, FD, LemmiLemmi CAE: Physical assessment findings CDCAE: Physical assessment findings CD--

ROM, Philadelphia, 2000, WB Saunders.ROM, Philadelphia, 2000, WB Saunders.


36

Shingles Shingles (cont(cont’’d.)d.)

�� Dermatome map:Dermatome map:



37

WartWart

�� Small, benign mass Small, benign mass

from rapid skin growth from rapid skin growth

�� Caused by HPVCaused by HPV


From From ZitelliZitelli B, Davis H: B, Davis H: Atlas of pediatric physical diagnosis,Atlas of pediatric physical diagnosis,

eded 5, 2007, Mosby.5, 2007, Mosby.


38

Inflammatory Skin DisordersInflammatory Skin Disorders

�� EczemaEczema

�� Contact dermatitisContact dermatitis

�� SeborrheicSeborrheic dermatitisdermatitis

�� PsoriasisPsoriasis

�� RosaceaRosacea

�� PityriasisPityriasis rosearosea

�� Lichen Lichen planusplanus

�� SclerodermaScleroderma

�� HivesHives


39

EczemaEczema

�� Chronic inflammatory Chronic inflammatory

disorderdisorder

�� Dry skin, scaling, may Dry skin, scaling, may

itch or burnitch or burn

�� Adjust pressure over Adjust pressure over

sensitive areas and sensitive areas and

avoid areas of broken avoid areas of broken

skinskin

From From HabifHabif T: T: Clinical dermatology: a color guide to diagnosis and Clinical dermatology: a color guide to diagnosis and

therapy,therapy, eded 4, St. Louis, 2004, Mosby.4, St. Louis, 2004, Mosby.


40

PsoriasisPsoriasis

�� Accelerated proliferation Accelerated proliferation

of epidermal cellsof epidermal cells

�� Elevated, thick, red skin Elevated, thick, red skin

covered with silvercovered with silver--white white

scales; dry plaquesscales; dry plaques

�� Adjust pressure over Adjust pressure over

sensitive areas and avoid sensitive areas and avoid

areas of inflamed or areas of inflamed or

broken skin broken skin

From From HabifHabif T, Campbell J, T, Campbell J, QuitadamoQuitadamo M, Zug K: M, Zug K: Skin disease: diagnosis and treatment,Skin disease: diagnosis and treatment, St. Louis, 2001, Mosby.St. Louis, 2001, Mosby.


41

Contact DermatitisContact Dermatitis

�� Inflammatory skin condition; types are irritant Inflammatory skin condition; types are irritant

and allergicand allergic

�� Rash with redness, swelling, and small Rash with redness, swelling, and small

vesicular lesionsvesicular lesions

�� Local contraindication in localized cases; Local contraindication in localized cases;

absolute contraindication in widespread casesabsolute contraindication in widespread cases


42

Contact Dermatitis Contact Dermatitis (cont(cont’’d.)d.)

From From HabifHabif: : Clinical dermatology: a color guide to diagnosis and therapy,Clinical dermatology: a color guide to diagnosis and therapy, eded 4, St. Louis, 2004, Mosby; and 4, St. Louis, 2004, Mosby; and HabifHabif T, Campbell J, T, Campbell J,

QuitadamoQuitadamo M, Zug K: M, Zug K: Skin disease: diagnosis and treatment,Skin disease: diagnosis and treatment, St. Louis, 2001, Mosby.St. Louis, 2001, Mosby.


43

SeborrheicSeborrheic DermatitisDermatitis

�� Chronic inflammatory Chronic inflammatory

condition of sebaceous condition of sebaceous

glandsglands

�� White to yellow, greasyWhite to yellow, greasy--

appearing scalesappearing scales

�� Adjust pressure overAdjust pressure over

hypersensitive areashypersensitive areasFrom FriedmanFrom Friedman--KienKien AE, AE, CockerellCockerell CJ: CJ: Color atlas of Color atlas of

AIDS,AIDS, eded 2, Philadelphia, 1996, WB Saunders.2, Philadelphia, 1996, WB Saunders.


44

RosaceaRosacea

�� Progressive inflammatory Progressive inflammatory skin diseaseskin disease

�� Persistent redness Persistent redness usually in middle third of usually in middle third of faceface

�� Adjust pressure over Adjust pressure over sensitive areas; avoid sensitive areas; avoid areas containing pustulesareas containing pustules

From From HabifHabif: : Clinical dermatology: a color guide to Clinical dermatology: a color guide to



45

PityriasisPityriasis RoseaRosea

�� SelfSelf--limiting, occurs most limiting, occurs most

often in winteroften in winter

�� Begins with a single Begins with a single

lesion (herald patch) lesion (herald patch)

spreading to a more spreading to a more

generalized rashgeneralized rash

�� Local contraindication in Local contraindication in

hypersensitive and hypersensitive and

inflamed areasinflamed areas

From From HabifHabif: : Clinical dermatology: a color guide to Clinical dermatology: a color guide to



46

Lichen Lichen PlanusPlanus

�� SelfSelf--limiting limiting

�� Rash of flatRash of flat--topped, redtopped, red-- to to

violetviolet--colored polygonal colored polygonal

papulespapules

�� Local contraindication in Local contraindication in

hypersensitive and hypersensitive and

inflamed areasinflamed areas

From From ZitelliZitelli B, Davis H: B, Davis H: Atlas of pediatric physical Atlas of pediatric physical

diagnosis, diagnosis, eded 5, 2007, Mosby.5, 2007, Mosby.


47

SclerodermaScleroderma

�� Autoimmune disease Autoimmune disease causing overproduction of causing overproduction of collagencollagen

�� Skin appears hard, shiny, Skin appears hard, shiny, and stretched across and stretched across bonesbones

�� Massage indicated; adjust Massage indicated; adjust pressure in sensitive or pressure in sensitive or numb areasnumb areas

From From CallenCallen J et al: J et al: Color atlas of dermatology,Color atlas of dermatology, eded 2, 2,

Philadelphia, 2000, WB Saunders.Philadelphia, 2000, WB Saunders.


48

Hives (Hives (UrticariaUrticaria))

�� Inflammation, edema, Inflammation, edema,

wheals; severe itchingwheals; severe itching

�� Most often cause is Most often cause is

unidentifiedunidentified


contraindicated in acute contraindicated in acute

cases; avoid affected cases; avoid affected

area in chronic casesarea in chronic cases

From From RoittRoitt I, I, BrostoffBrostoff J, Male D: J, Male D: Immunology,Immunology,

eded 6, St. Louis, 2001, Mosby.6, St. Louis, 2001, Mosby.


49


�� Contrast and compare lice and mites.Contrast and compare lice and mites.

�� Define miscellaneous skin injuries and discuss Define miscellaneous skin injuries and discuss

other skin disorders.other skin disorders.

�� Delineate types of skin pigmentation.Delineate types of skin pigmentation.

�� Name benign and premalignant skin proliferations Name benign and premalignant skin proliferations

and determine their appropriate massage and determine their appropriate massage

considerations.considerations.


50

Lice and MitesLice and Mites

�� LiceLice

�� ScabiesScabies


51

LiceLice

�� Contagious parasitic infestationContagious parasitic infestation

�� Presence of nits on hair shaft; rash on scalp, Presence of nits on hair shaft; rash on scalp,

neck and shouldersneck and shoulders

�� Massage is contraindicatedMassage is contraindicated

A, from A, from HabifHabif T, Campbell J, T, Campbell J, QuitadamoQuitadamo M, Zug K: M, Zug K: Skin disease: diagnosis and treatment,Skin disease: diagnosis and treatment, St. Louis, 2001, Mosby; B, Courtesy of St. Louis, 2001, Mosby; B, Courtesy of

Michael Sherlock, M.D., Lutherville, MD. In Michael Sherlock, M.D., Lutherville, MD. In ZitelliZitelli B, Davis H: B, Davis H: Atlas of pediatric physical diagnosis,Atlas of pediatric physical diagnosis, eded 5, Philadelphia, 2007, Mosby.5, Philadelphia, 2007, Mosby.


52

ScabiesScabies

�� Contagious burrowing parasitic mite infestationContagious burrowing parasitic mite infestation

�� Rash of thin, tiny, light brown lines in skin creasesRash of thin, tiny, light brown lines in skin creases

�� Massage is contraindicatedMassage is contraindicated



53

Skin InjuriesSkin Injuries

�� BruisesBruises

�� BurnsBurns

�� Stretch marksStretch marks

�� ScarsScars

�� Corns and callusesCorns and calluses

�� DecubitusDecubitus ulcersulcers


54

BruiseBruise

�� Injury that does not break the skin; usually Injury that does not break the skin; usually

induced by mechanical traumainduced by mechanical trauma

�� Swelling, discoloration (blood leaked from Swelling, discoloration (blood leaked from

broken vessels), tenderness, painbroken vessels), tenderness, pain

�� Avoid the area until it begins to turn greenishAvoid the area until it begins to turn greenish--

yellow; adjust pressure over sensitive areasyellow; adjust pressure over sensitive areas


55

BurnsBurns

�� Skin injury caused by heat, cold, radiation, Skin injury caused by heat, cold, radiation, chemicals, electricity, or frictionchemicals, electricity, or friction

�� FirstFirst--degree burn: damage to epidermisdegree burn: damage to epidermis

�� SecondSecond--degree burn: damage to epidermis and degree burn: damage to epidermis and upper layers of dermisupper layers of dermis

�� ThirdThird--degree burn: destruction of epidermis, degree burn: destruction of epidermis, dermis, follicles, skin glandsdermis, follicles, skin glands

�� Postpone massage until affected area Postpone massage until affected area completely heals; adjust pressure over sensitive completely heals; adjust pressure over sensitive or numb areas or numb areas


56

Burns Burns (cont(cont’’d.)d.)

�� First degree burnFirst degree burn

From Judd RL, From Judd RL, PonsellPonsell PP: PP: MosbyMosby’’s first responder,s first responder, eded 2, St. Louis, 1988, Mosby.2, St. Louis, 1988, Mosby.

�� Second degree burnSecond degree burn

�� Third degree burnThird degree burn


57

�� Rule of NinesRule of Nines

From Frazier MS, From Frazier MS, DrymkowskiDrymkowski JW: JW: Essentials of human diseases and conditions,Essentials of human diseases and conditions, eded 2, Philadelphia, 2000, WB Saunders.2, Philadelphia, 2000, WB Saunders.


58

Stretch MarksStretch Marks

�� Tearing, thinning, for overstretching of skin; Tearing, thinning, for overstretching of skin; reduces its thicknessreduces its thickness

�� RedRed--pink streaks that eventually turn silvery whitepink streaks that eventually turn silvery white

�� Reduce pressure over affected areasReduce pressure over affected areas

From From HabifHabif: : Clinical dermatology: a color guide to diagnosis and therapy,Clinical dermatology: a color guide to diagnosis and therapy, eded 4, St. Louis, 2004, Mosby.4, St. Louis, 2004, Mosby.


59

ScarsScars

�� Mark left on damaged skin after it is healedMark left on damaged skin after it is healed

�� Can be flat and pale, slightly elevated, or form Can be flat and pale, slightly elevated, or form

depressions; two types of abnormal scars depressions; two types of abnormal scars

caused by excess collagen production are: caused by excess collagen production are:

�� Hypertrophic (raised)Hypertrophic (raised)

�� KeloidKeloid (raised and extend beyond boundaries of (raised and extend beyond boundaries of

original wound)original wound)

�� Postpone massage until the area completely Postpone massage until the area completely

heals; adjust pressure over sensitive areasheals; adjust pressure over sensitive areas


60

Scars Scars (cont(cont’’d.)d.)



61

Corn and CallusCorn and Callus

�� Skin thickening from repeated Skin thickening from repeated

friction or pressure friction or pressure

�� Corn: top and sides of toeCorn: top and sides of toe

�� Callus: hands or sides and soles Callus: hands or sides and soles

of the feet of the feet

�� Adjust pressure or avoid Adjust pressure or avoid

affected area affected area

From White GM: From White GM: Color atlas of regional dermatologyColor atlas of regional dermatology, St , St

Louis , 1994, Mosby; and Lawrence CM, Cox NH: Louis , 1994, Mosby; and Lawrence CM, Cox NH:

Physical signs in dermatology: color atlas and text,Physical signs in dermatology: color atlas and text, eded 2, 2,

London, 2002, Mosby Europe.London, 2002, Mosby Europe.

CornCorn

CallusCallus


62

DecubitusDecubitus UlcerUlcer

�� Caused by local ischemia on area subjected to Caused by local ischemia on area subjected to prolonged pressureprolonged pressure

�� Classified in four stages (I, II, III, IV)Classified in four stages (I, II, III, IV)

�� Signs and symptoms dependant on stage of Signs and symptoms dependant on stage of severityseverity

�� Avoid affected area within a 4Avoid affected area within a 4--inch radius inch radius around ulceraround ulcer’’s edges edge


63

DecubitusDecubitus Ulcer Ulcer (cont(cont’’d.)d.)

Stage IStage I Stage IIStage II

Stage IIIStage III Stage IVStage IV

From Courtesy Laurel From Courtesy Laurel WiersmaWiersma, RN, MSN, Clinical Nurse Specialist, Barnes, RN, MSN, Clinical Nurse Specialist, Barnes--Jewish Hospital, St. Louis. In Potter PA, Perry AG: Jewish Hospital, St. Louis. In Potter PA, Perry AG:

Fundaments of nursing,Fundaments of nursing, eded 7, St. Louis, 2009, Mosby.7, St. Louis, 2009, Mosby.


64

Other Skin DisordersOther Skin Disorders

�� IchthyosisIchthyosis vulgarisvulgaris

�� Epidermal cystEpidermal cyst

�� Skin pigmentationsSkin pigmentations


65

IchthyosisIchthyosis VulgarisVulgaris

�� Disruption of skin cell Disruption of skin cell

generation and removalgeneration and removal

�� Causes skin thickening Causes skin thickening

and scalingand scaling

�� Use emollient cream and Use emollient cream and

adjust pressure over adjust pressure over

sensitive areas; avoid sensitive areas; avoid

areas of broken skinareas of broken skin



66

Epidermal CystEpidermal Cyst

�� Benign pouch filled with Benign pouch filled with

keratinous materialkeratinous material

�� Located beneath the Located beneath the

skin, easily palpable, skin, easily palpable,

and usually mobile and usually mobile




67

Skin PigmentationsSkin Pigmentations

�� Birthmarks (Moles, cafBirthmarks (Moles, caféé--auau--laitlait spots, Mongolian spots, Mongolian

blue spots, beauty marks)blue spots, beauty marks)

�� HemangiomasHemangiomas (Strawberry and cherry (Strawberry and cherry

hemangiomashemangiomas, port wine stains, stork bites, , port wine stains, stork bites,

angelangel’’s kiss)s kiss)

�� Age spots (solar Age spots (solar lentigolentigo, senile , senile lentigolentigo, liver , liver

spots)spots)


68

Skin PigmentationsSkin Pigmentations

�� Freckles (Freckles (ephelisephelis))

�� MelasmaMelasma ((chloasmachloasma, mask of pregnancy), mask of pregnancy)

�� Albinism (Albinism (hypopigmentationhypopigmentation))

�� VitiligoVitiligo ((leukodermaleukoderma))


69

Benign and Premalignant Skin Benign and Premalignant Skin

ProliferationsProliferations

�� Actinic Actinic keratosiskeratosis

�� SeborrheicSeborrheic keratosiskeratosis

�� Skin tagsSkin tags


70

Actinic Actinic KeratosisKeratosis

�� Premalignant; found on Premalignant; found on

sunlightsunlight--exposed skinexposed skin

�� Yellow, brown, or red Yellow, brown, or red

lesions; rough scaly lesions; rough scaly

surfacesurface




71

SeborrheicSeborrheic KeratosisKeratosis

�� Benign growth of Benign growth of epidermal cellsepidermal cells

�� Lesions have waxy or Lesions have waxy or scaly surface and scaly surface and appearance of being appearance of being stuck or pasted on stuck or pasted on




72

Skin TagsSkin Tags

�� Benign skin growthsBenign skin growths

�� Resemble tiny flaps Resemble tiny flaps of skin attached by a of skin attached by a narrow stalk narrow stalk

�� Adjust pressure if Adjust pressure if affected area is affected area is sensitivesensitive


mosby’s pathology lesson 4.1 objectives … · corn and callus skin thickening from repeated...

Documents